New Provider Training
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- Constance Caldwell
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1 New Provider Training
2 Overview (available 24/7): Public Health PAS Website Secure Health PAS Website 2
3 Public Health PAS Website
4 Navigating the Website 4
5 Provider Directory 5
6 Contact Us 6
7 Contact Us Additional Contacts 7
8 Navigating the Website Menus Hover over for links 8
9 Reference Material Provider Handbook 9
10 Reference Material FAQs 10
11 Reference Material MedicAide Newsletters 11
12 MedicAide Newsletter Example 12
13 Reference Material Fee Schedules 13
14 Fee Schedule 14
15 Reference Material Information Releases 15
16 Reference Material Announcements 16
17 Announcement Example 17
18 Reference Material Companion Guides 18
19 Reference Material User Guides 19
20 Reference Material Registered Billing Agencies 20
21 Reference Material Training 21
22 Reference Material Participant Information 22
23 Reference Material DHW Forms 23
24 Reference Material Molina Forms 24
25 Secure Health PAS Website
26 Trading Partner Sign In 26
27 Form Entry 27
28 View Authorizations 28
29 Authorization Search 29
30 Authorization Details 30
31 Claim Submission 31
32 Claim Submission Two pieces of identifying information are required 32
33 Claim Submission Professional (1500) Claim Make sure pop up blockers are off 33
34 Claim Submission COB Information 34
35 Claim Submission Institutional (UB04) Claim 35
36 Claim Submission Institutional (UB04) Claim Make sure pop up blockers are off 36
37 Claim Submission Tips Refer to the following sections of the Provider Handbook for more information on claims submission. CMS 1500 Instructions UB04 Instructions General Billing Instructions Allopathic and Osteopathic Physicians (for NDC drug codes) The Provider Handbook is located at 37
38 Splitting Claims Splitting Claims Is Necessary When: A PA number changes in the middle of your DOS range (electronic billers only) The participant has an enrollment change The provider has a rate change A claim with primary insurance that has covered and noncovered services Services span from one month to the next month Services span from one year to the next year 38
39 Claim Tools Adjudication Allows you to see any outstanding claim edits. You can adjudicate a claim in OPEN or PEND status. It is the best practice to not adjudicate secondary claims and if you choose not to the claim will be picked up in the mass nightly adjudication. Editing Can be done on claims that are in an OPEN, ADJUDICATED, PAY, PEND, or DENY status Reverse and Create New Claim Can take place on a claim that has been processed through a payment cycle and has a DENIED or PAID status o Select Reverse this Claim Only for claims that should not have received a Medicaid payment Copy Last Claim Allows the provider to bill claims with information from the last claim submitted Add Attachments You can add documentation, such as EOBs from primary insurance or supporting medical documentation for services provided Patient Roster A provider-created list of participants associated with a particular billing provider 39
40 Claim Status 40
41 Claim Status Search 41
42 Claim Status Search Results 42
43 Claim Status Edit Note: Editing a claim may not always reset the claim status 43
44 Claim Status Adjudicate Note: You may also receive a message indicating Adjudicated Successfully 44
45 Claim Status Reverse 45
46 Claim Status Add Attachments 46
47 Eligibility Verification Two pieces of identifying information are required 47
48 Eligibility Verification Dates of Service 48
49 Eligibility Receipt 49
50 Patient Roster 50
51 Patient Roster Add New Member Two pieces of identifying information are required 51
52 Patient Roster Actions 52
53 Primary Care Roster 53
54 Referral Submission 54
55 LTC Case Status and Submission 55
56 LTC Case Submission Two pieces of identifying information are required 56
57 Provider Payment Status 57
58 Payment Detail 58
59 Referral Status & Submission 59
60 Enrollment and Maintenance
61 Enrollment/Maintenance Be sure to keep your information up to date. o o o o o Current contact Mailing/W9/physical/ addresses Adding and terming rendering providers Adding and terming service locations Change of ownership 61
62 Account Maintenance 62
63 Enrollment and Maintenance 63
64 Maintenance Forms 64
65 Provider Maintenance Maintenance is required when any information changes: Physical, mailing, and address Add, term, update service locations Rendering or service provider changes Name changes Change in ownership Note: Contact updates are made through Maintenance Demographic. 65
66 File Exchange 66
67 Tips Use current forms Complete all sections of the form use N/A when appropriate Utilize the Provider Enrollment Requirements document in the Provider Handbook for type and specialty information, as well as additional requirements New W9 for 1099 changes W9 name and tax ID must match IRS records Update provider credentials (licenses, certifications, insurance, etc.) 67
68 Tips License Updates Updated Credentials: License As long as there are no changes to information, license updates are not required if you are licensed with the following: Idaho State Board of Nursing Idaho State Board of Medicine Idaho State Board of Pharmacy 68
69 Tips Provider Maintenance The Molina Medicaid website ( has the following resources: Provider Enrollment - Verifying Enrollment Application Status Provider Handbook User Guides Contact Molina at 1 (866) or idproviderenrollment@molinahealthcare.com for assistance with enrollment or maintenance 69
70 Provider Relations Consultants Region 1 and the state of Washington 1 (208) Region.1@MolinaHealthCare.com Region 2 and the state of Montana 1 (208) Region.2@MolinaHealthCare.com Region 3 and the state of Oregon 1 (208) Region.3@MolinaHealthCare.com Region 4 and all other states 1 (208) Region.4@MolinaHealthCare.com Region 5 and the state of Nevada 1 (208) Region.5@MolinaHealthCare.com Region 6 and the state of Utah 1 (208) Region.6@MolinaHealthCare.com Region 7 and the state of Wyoming 1 (208) Region.7@MolinaHealthCare.com 70
71 Thank you for attending our New Provider Training. Please take a few minutes to complete the evaluation. This provides us with valuable information for future trainings.
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